Purpose of Review This review summarises the epidemiology of Candida auris infection and describes contemporary and emerging diagnostic methods for detection and identification of C. auris . Recent Findings A fifth C. auris clade has been described. Diagnostic accuracy has improved with development of selective/differential media for C. auris . Advances in spectral databases of matrix-associated laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) systems have reduced misidentification. Direct detection of C. auris in clinical specimens using real time PCR is increasingly used, as is whole genome sequencing (WGS) to track nosocomial spread and to study phylogenetic relationships and drug resistance. Summary C. auris is an important transmissible, nosocomial pathogen. The microbiological laboratory diagnostic capacity has extended beyond culture-based methods to include PCR and WGS. Microbiological techniques on the horizon include the use of MALDI-TOF MS for early echinocandin antifungal susceptibility testing (AST) and expansion of the versatile and information-rich WGS methods for outbreak investigation.

Background: The Northern Sydney Local Health District was one of the first health regions to be affected by COVID-19 in Australia.Aims: To describe the clinical characteristics, risk factors and outcomes in our lowprevalence Australian population.Methods: This is a retrospective analysis of 517 laboratory-confirmed COVID-19 cases between January and June 2020. Patient information was collected as part of routine care within the COVID-19 Virtual Hospital system. Outcomes examined were death, recovery at 30 days and intensive care unit (ICU) admission. Results:The case fatality rate was 1.8%. Multivariate analysis showed factors independently associated with death, composite outcome of death/ICU admission or incomplete recovery at 30 days were age >80 years and presence of two or more comorbidities. Most cases acquired COVID-19 through international (50.9%) or cruise ship travel (9.1%). Healthcare workers comprised 12.8% of the cohort and represented a disproportionately high percentage of the 'unknown' source group (27.6%). The median incubation period was 5 days (interquartile range 3-8); one patient had an incubation period of 15 days. Hospitalisation was required in 11.8%, ICU admission in 2.1% and ventilation in 1.4%. A Radiographic Assessment of Lung Oedema score on chest X-ray of >10 was independently associated with death. Conclusions:In this low prevalence, well resourced Australian setting, we report an overall low mortality. Factors associated with adverse patient outcomes on multivariate analysis were age greater than 80 and the presence of two or more comorbidities. These data can assist in early risk stratification of COVID-19 patients, and in surge capacity planning for hospitals.

There are emerging cases of immune-mediated diseases post COVID-19 vaccination. 1 We report a case of adultonset Still disease (AOSD) after adenoviral vector vaccination (AstraZeneca). There has been one other case in the literature of documented AOSD post-adenoviral vector vaccination; the present case lends weight to a possible rare association.Mr NS, a 53-year-old marathon runner with no significant past medical history, presented to his general practitioner with a 1-week history of fatigue post initial vaccination with ChAdOx1 nCoV-19/AZD1222 (AstraZeneca). Workup at that stage was unremarkable. Ten weeks following his vaccination, he was urgently referred to the Emergency Department on 22 July 2021 with headache, arthralgia, malaise and fatigue. He was also noted to be thrombocytopenic with a platelet count of 88 Â 10 9 /L (reference range 150-400) associated with a raised D-dimer of 2.36 μg/mL FEU (reference range 0.00-0.40), and there was concern regarding the risk of thrombosis with thrombocytopenia.He complained of a 2-week history of worsening headaches, arthralgia, pharyngitis, rash and drenching sweats. Examination revealed, quotidian fevers of >39 C and a salmon-coloured rash over the anterior chest, back and limbs (Fig. 1). Mr NS was extremely stiff with pain on movement of the knees, in particular the left side, and no joint effusion was noted. Mild weakness was noted at the hip and shoulder girdles with difficulty sustaining muscle resistance. No lymphadenopathy was noted.Investigations carried out in the community 2 days prior to admission revealed: C-reactive protein (CRP) 56 mg/L (reference range <5), ferritin 3140 μg/L (reference range 30-300), erythrocyte sedimentation rate (ESR) 17 mm (reference range 1-15), aspartate aminotransferase 68 U/L (reference range 10-40) and alanine transaminase 62 U/L (reference range 5-40). During admission, levels of ferritin, CRP and ESR peaked at 10200 μg/L, 237 mg/L and 85 mm/h, respectively. In the setting of thrombocytopenia with raised D-dimer, a computed tomography pulmonary angiogram scan was performed that ruled out pulmonary embolism; no pulmonary infiltrate was noted. Abdominal ultrasound confirmed mild splenomegaly without lymphadenopathy.

Background: Early, accurate diagnosis of invasive fungal disease (IFD) improves clinical outcomes. 1,3-beta-D-glucan (BDG) (Fungitell, Associates of Cape Cod, Inc., Falmouth, MA, USA) detection can improve IFD diagnosis but has been unavailable in Australia. Aims: To assess performance of serum BDG for IFD diagnosis in a high-risk Australian haematology population. Methods: We compared the diagnostic value of weekly screening of serum BDG with screening by Aspergillus polymerase chain reaction and Aspergillus galactomannan in 57 at-risk episodes for the diagnosis of IFD (proven, probable, possible IFD).Results: IFD episodes were: proven (n = 4); probable (n = 4); possible (n = 18); and no IFD (n = 31). Using two consecutive BDG results of ≥80 pg/mL to call a result 'positive', the sensitivity, specificity, positive predictive value and negative predictive value was 37.5%, 64.5%, 23.1% and 80.7% respectively. For invasive aspergillosis, test performance increased to 50%, 90.3%, 57.1% and 87.5% respectively if any two of serum BDG/Aspergillus polymerase chain reaction/galactomannan yielded a 'positive' result. In proven/probable IFD, five of eight episodes returned a positive BDG result earlier (mean 6.6 days) than other diagnostic tests. False-negative BDG results occurred in three of eight episodes of proven/probable IFD, and false positive in 10 of 31 patients with no IFD. Erratic patterns of BDG values predicted false positive results (P = 0.03). Using serum BDG results, possible IFD were reassigned to either 'no' or 'probable' IFD in 44% cases. Empiric anti-fungal therapy use may have been optimised by BDG monitoring in 38.5% of courses. Conclusions:The BDG assay can add diagnostic speed and value but was hampered by low sensitivity and positive predictive value in Australian haematology patients.